is this related to infection or ?

[blueskyabq]

Hi Dr,

What do you think about the following case.

A health male in early 50's, with no family history of prostate cancer.  In his later forty's, annual exam showed PSA were in 1.3-1.4 level.  A most recant one, after 18 month of the last test, PSA somehow shot in higher lever ,  a couple of them were consider took right after DRE or other exam may course the elevated PSA.  Later repeat in a month showed PSA range 4 - 2.5 (a few days after DRE or test involved in a message of prostate).  

Dr consider infection, so he took a course of antibiotics. After that, the first repeat test show PSA is 1.8.  

What do you think about this case? IS infection?  If he is your patient, what will be your recommendation?  Will you still think biopsy is necessary?

BTW, anyway can diagnosis for infection?  Why most urologist will not conduct the tests?

Thank you in advance for your advise and help!

[blueskyabq]

Thank you!  Your time and advise is greatly appreciated.

If it was caused by infection, then this course of antibiotics take care of problem, then is it likely, need more antibiotics later, if repeat PSA raise again?  Is there any way can test and diagnosis for infection?

[Ketan K Badani]

There are several factors that can elevate a PSA other can prostate cancer.  Some of which include urinary infection, prostatitits, DRE, inflammatory problems, etc.  If your PSA's have been in the 1.8 range and then quickly return to 1.8 after a course of antibiotics I would attribute to an infection/inflammation.  Still, a careful surveillance strategy of repeat PSA to ensure it stays low is important.  In most cases of young men, the absolute number of PSA is important, but more important can be the rate of rise in the PSA.  I would repeat the PSA again to confirm the 1.8 and then get your screening PSA's and DRE's regularly.